妊娠肥胖、妊娠糖尿病与脂肪因子的关系研究

A study on relationgship between obesity during pregnancy, GDM and serum levels of adipocytokines

目的探讨妊娠肥胖、妊娠期糖尿病患者血清脂肪因子水平变化及其影响因素。方法采用酶联免疫吸附法检测26例孕前肥胖妊娠期糖尿病孕妇、30例孕前非肥胖妊娠期糖尿病孕妇、25例单纯肥胖孕妇及28例正常健康孕妇血清视黄醇结合蛋白-4、肿瘤坏死因子-α、脂联素水平；同时测定所有受试者的糖、脂生化指标，并计算胰岛素抵抗指数。结果①妊娠期糖尿病孕妇血清胰岛素、胰岛素抵抗指数高于非妊娠期糖尿病孕妇（F值分别为72．16，59．38，均P〈0．01）；②孕前肥胖妊娠期糖尿病孕妇血清肿瘤坏死因子-α、视黄醇结合蛋白-4水平明显高于其他三组孕妇（F值分别为40．83，16．42，尸均〈0．01）。妊娠期糖尿病孕妇血清脂联素水平明显低于非妊娠期糖尿病孕妇，单纯肥胖孕妇血清脂联素水平较正常健康孕妇低（F=90．12，P〈0．01）。单纯肥胖孕妇视黄醇结合蛋白-4水平高于非肥胖孕妇；③肿瘤坏死因子-α水平与孕前身体质量指数、视黄醇结合蛋白一4水平以及胰岛素抵抗指数成正相关（r值分别为0．278，0．533，0．596，P值分别为〈0．05、〈0．01、〈0．01），与脂联素水平成负相关（r=-0．537，P〈0．01），血清脂联素水平与胰岛素抵抗指数、视黄醇结合蛋白-4水平成负相关（r值分别为-0．719，-0．408，均P〈0．01），血清视黄醇结合蛋白-4与孕前身体质量指数、胰岛素抵抗指数成正相关（r值分别为0．766，0．465，均P〈0．01）。结论妊娠期糖尿病孕妇及肥胖孕妇存在胰岛素抵抗，妊娠期糖尿病孕妇血清中肿瘤坏死因子-α水平上升，脂联素水平下降，血清视黄醇结合蛋白-4水平与肥胖密切相关，脂肪细胞因子之间相互抑制或相互促进，参与肥胖或妊娠期糖尿病的发生。

Objective To investigate changes in serum levels of adipocytokines of pregnant women with obesity or gestational diabetes melittus （GDM） and their influencing factors. Methods Serum levels of retinol binding protein-4 （ RBP-4）, tumor necrosis factor-α （TNF-α） and adiponectin （APN） of 26 pregnant women with GDM who had had obesity before pregnancy, 30 pregnant women with GDM who had normal body weight before pregnancy, 25 pregnant women with simple obesity and 28 pregnant women with normal body weight during pregnancy were detected by using enzyme-linked immunosorbent assay （ELISA）. Meanwhile, FINS, FPG, TC, TG, HDL-C, LDL- C of all subjects were detected and their homeostatic model assessment-insulin resistance （HOMA-IR） index was caculated. Results （1） The serum levels of FINS and HOMA-IR index of pregnant women with GDM were significantly higher than those of pregnant women without GDM（F=72. 16,59.38 respectively, both P 〈0.05）. And the serum levels of FINS and HOMA-IR index were higher in the obese pregnant women group than the normal pregnant women group （ both P 〈 0. 001 ） ; （2）The serum levels of TNF-α and RBP-4 in GDM pregnant women with pregestational obesity group were higher than other three groups （ F = 40.83,16.42 respectively, both P 〈 0. 01 ）. While the serum level of APN of pregnant women with GDM was lower than that of those pregnant women without GDM and the serum level of APN of pregnant women with simple obesity was also lower than that of normal pregnant women（ F = 90.12 ,P 〈 0.01 ） ; （3）The serum level of TNF-α was significantly positively correlated to pregestational body mass index （ BMI）, serum RBP-4 level and HOMA-IR index （r =0.278,0. 533,0.596 respectively, P 〈 0.05, P 〈 0.01, P 〈 0.01 ）,but it was negatively correlated to serum level of APN （r = - 0.537, P 〈 0.01 ）. The serum level of APN was negatively correlated to HOMA-IR index and serum RBP-4 level （ r = - 0. 719, - 0.408 respectively, both P 〈0.01 ）. And the serum level of RBP-4 was positively correlated to pregestational BMI and HOMA-IR index （r = 0. 766 ,0. 465 respectively, both P 〈 0.01 ）. Conclusion The pregnant women with GDM or simple obesity have insulin resistance （IR）. The serum level of TNF-α of pregnant women with GDM is increased while their serum level of APN is decreased. The serum level of RBP- 4 of the pregnant women is closely related to obesity. Interactions between adipocytokines may be involved in pathogenesis of obesity or GDM.